Senate Tackles Health Package

TALLAHASSEE -- Legislators, after weeks of wrangling over stacks of proposals, may be on the verge of producing a plan to bring affordable health insurance to all Floridians.

The question is whether Gov. Lawton Chiles will buy it.

On Wednesday night, the Senate by a 23-17 vote adopted not a final bill, but a 227-page amendment that is nearly identical to measures that long ago cleared the House.

One difference: The new Senate proposal, sponsored by Sen. William ``Doc`` Myers, R-Hobe Sound, a physician, would give doctors more power over how they participate in the new ``managed competition`` system -- a move that some say could subvert reform and drive up costs.

Today, the Senate is expected to take a final vote on its health care package, but only after pushing through a thicket of proposed amendments.

``It`s 99 percent the same,`` said House Health Care Committee Chairman Rep. Ben Graber, D-Coral Springs, of the plan taken up by the full Senate. ``I`m very encouraged. ... This tells me we`re going to have a health care plan this year.``

The Senate compromise retains the basic ``managed competition`` model pioneered by Chiles and his negotiator on this issue, Doug Cook, who heads the Agency for Health Care Administration.

Large non-profit buying co-ops, known as community health purchasing alliances, would be set up in 11 regions of the state. Small employers (whose workers and their families make up most of the 2.5 million Floridians who are uninsured) could join, along with state employees and Medicaid participants.

The alliances` clout would be in their size, and doctors, hospitals and insurers could negotiate to provide them with affordable insurance.

Chiles, though, has insisted that the alliances and the health care agency must be powerful enough to shake up the health care status quo. For instance, he wants the alliances to have some purchasing power, rather than just being neutral data collectors.

``I don`t want to scare people ... but I don`t want to climb this far and say we didn`t end up doing something,`` Chiles said on Wednesday when conferring with House members on the issue.

Replied Graber, I just want to make sure (the plan) doesn`t get scuttled by too much ambition. We have to learn when to hold back.``

For a moment, the situation on Wednesday night looked more like the stalemates that bedeviled the Senate last year. On a 20-20 vote along partisan lines, senators rejected a massive Gutman health care proposal.

Sen. Patricia Grogan, D-Merritt Island, even left her hospital bed, where she had been recovering from compound fractures of her right arm, to bolster the Democrats` ranks.

``I`ve had better days,`` she said wanly.

But in the end, the senators sought compromise, going with a plan that is less government-controlled.

-- BUYING CHOICES: Insurers and health care providers negotiate on providing insurance plans to CHPA members, who get price breaks because of their numbers. Plans range from allowing for full choice of doctors to less expensive, limited-choice options.

-- WHO GETS INSURED: Small employers are guaranteed access to insurance -- regardless of their employees` health status -- and guaranteed to pay the same price as anyone else for the same benefits.

Only age, gender, family composition, tobacco use and geographic location can be considered in modifying rates.

People with pre-existing medical conditions can get coverage, but in certain instances must wait 1-2 years for that condition to be covered.

-- COST CUTTING: Doctors and hospitals must report on success rates for treatment and efficiency (how many tests ordered, drugs prescribed etc.). Data will be used to evaluate cost-effective ways to deliver quality care.

``Practice parameters`` are established to spell out good medical treatment for particular illnesses. Doctors can use these as a defense in malpractice cases.

-- MEDICAID BUY-IN: Any family whose income is 250 percent of the poverty level and who has been uninsured for a year can buy a basic health insurance plan from the state.

If a federal Medicaid waiver is obtained, these policies could become government-subsidized on a sliding scale, based on income.

KEY ISSUES OF CONTENTION

CONTROL OF NEW SYSTEM

-- Governor wants alliances to act as a mass purchaser, not just a facilitator and data collector. Not in House plan.

-- Governor wants authority to remove alliance board members. Not in House plan.

-- Governor wants to transfer regulation of medical professions to health agency. Included in House plan.

-- Governor wants to elevate Agency for Health Care Administration to a department and expand its powers. Not in House plan.

SIZE OF SYSTEM

-- Governor wants to include state employees and Medicaid participants in alliances. Included in House plan.